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Do No Harm – Except to Women

Ema at The Well Timed Period has this fantastic post up detailing just how easy it is for doctors to refuse reproductive health care to women. Go read it. She’s responding to this article, which discusses all the different ways that women’s health is compromised by ideologues in white coats. And it is disturbing as all hell.

It begins with the story of a rape survivor who was denied emergency contraception in the ER:

Lori Boyer couldn’t stop trembling as she sat on the examining table, hugging her hospital gown around her. Her mind was reeling. She’d been raped hours earlier by a man she knew—a man who had assured Boyer, 35, that he only wanted to hang out at his place and talk. Instead, he had thrown her onto his bed and assaulted her. “I’m done with you,” he’d tonelessly told her afterward. Boyer had grabbed her clothes and dashed for her car in the freezing predawn darkness. Yet she’d had the clarity to drive straight to the nearest emergency room—Good Samaritan Hospital in Lebanon, Pennsylvania—to ask for a rape kit and talk to a sexual assault counselor. Bruised and in pain, she grimaced through the pelvic exam. Now, as Boyer watched Martin Gish, M.D., jot some final notes into her chart, she thought of something the rape counselor had mentioned earlier.

“I’ll need the morning-after pill,” she told him.

Dr. Gish looked up. He was a trim, middle-aged man with graying hair and, Boyer thought, an aloof manner. “No,” Boyer says he replied abruptly. “I can’t do that.” He turned back to his writing.

Boyer stared in disbelief. No? She tried vainly to hold back tears as she reasoned with the doctor: She was midcycle, putting her in danger of getting pregnant. Emergency contraception is most effective within a short time frame, ideally 72 hours. If he wasn’t willing to write an EC prescription, she’d be glad to see a different doctor. Dr. Gish simply shook his head. “It’s against my religion,” he said, according to Boyer. (When contacted, the doctor declined to comment for this article.)

Boyer left the emergency room empty-handed. “I was so vulnerable,” she says. “I felt victimized all over again. First the rape, and then the doctor making me feel powerless.” Later that day, her rape counselor found Boyer a physician who would prescribe her EC. But Boyer remained haunted by the ER doctor’s refusal—so profoundly, she hasn’t been to see a gynecologist in the two and a half years since. “I haven’t gotten the nerve up to go, for fear of being judged again,” she says.

We tend to forget the long-lasting effects of these kinds of judgments. Not only was this woman denied the health care she requested — health care that could prevent her from being impregnated by her rapist — she was further psychologically traumatized. Rape is a crime of violence and control, and it’s crucial for rape survivors to feel that they are able to regain control over their bodies. This doctor took that away from her, because he believes that a potentially fertilized egg is more important than his patient. That is shameful.

The stakes were high for Realtor Cheryl Bray when she visited a physician in Encinitas, California, two and a half years ago. Though she was there for a routine physical, the reason for the exam was anything but routine: Then a single 41-year-old, Bray had decided to adopt a baby in Mexico and needed to prove to authorities there that she was healthy. “I was under a tight deadline,” Bray remembers; she had been matched with a birth mother who was less than two months from delivering. Bray had already passed a daunting number of tests—having her taxes certified, multiple background checks, home inspections by a social worker, psychological evaluations. When she showed up at the office of Fred Salley, M.D., a new doctor a friend had recommended, she was looking forward to crossing another task off her list. Instead, 10 minutes into the appointment, Dr. Salley asked, “So, your husband is in agreement with your decision to adopt?”

“I’m not married,” Bray told him.

“You’re not?” He calmly put down his pen. “Then I’m not comfortable continuing this exam.”

Bray says she tried to reason with Dr. Salley but received only an offer for a referral at some future date. Dr. Salley disputes this, telling SELF that he offered to send Bray to another doctor in his group that day. “My decision to refer Ms. Bray was not because she was unmarried; rather, it was based on my moral belief that a child should have two parental units,” he adds. “Such religious beliefs are a fundamental right guaranteed by the Constitution of the United States.”

Yes, religious freedom is guaranteed by the Constitution — and it’s a crucial right that I don’t want to see taken away. But it’s long been established that religious freedom has to be balanced with workplace obligations. I think it’s fair to require workplaces to make reasonable accomodations for religious people. I’m not so sure it’s fair for an employee to refuse to do their job because of their religion. If you follow Jainism and feel it is utterly morally wrong to consume animal products, you probably should not apply to be a cook in a non-vegetarian restaurant.

Allowing a person to wear unobtrusive religious clothing items is a fair accomodation. Allowing someone to take Saturday off instead of Sunday is a fair accomodation. Allowing an employee a break to pray is a fair accomodation.

Allowing an employee to compromise someone’s health when their job is to provide health care is not a fair accomodation. Case in point:

If there’s one thing both sides can agree on, it’s this: In an emergency, doctors need to put aside personal beliefs to do what’s best for the patient. But in a world guided by religious directives, even this can be a slippery proposition.

Ob/gyn Wayne Goldner, M.D., learned this lesson a few years back when a patient named Kathleen Hutchins came to his office in Manchester, New Hampshire. She was only 14 weeks pregnant, but her water had broken. Dr. Goldner delivered the bad news: Because there wasn’t enough amniotic fluid left and it was too early for the fetus to survive on its own, the pregnancy was hopeless. Hutchins would likely miscarry in a matter of weeks. But in the meanwhile, she stood at risk for serious infection, which could lead to infertility or death. Dr. Goldner says his devastated patient chose to get an abortion at local Elliot Hospital. But there was a problem. Elliot had recently merged with nearby Catholic Medical Center—and as a result, the hospital forbade abortions.

“I was told I could not admit her unless there was a risk to her life,” Dr. Goldner remembers. “They said, ‘Why don’t you wait until she has an infection or she gets a fever?’ They were asking me to do something other than the standard of care. They wanted me to put her health in jeopardy.” He tried admitting Hutchins elsewhere, only to discover that the nearest abortion provider was nearly 80 miles away in Lebanon, New Hampshire—and that she had no car. Ultimately, Dr. Goldner paid a taxi to drive her the hour and a half to the procedure.

That’s right: She had to come in with an infection before she could get the health care she needed. Keep in mind that her fetus was going to die, but it could take weeks for her to miscarry. Carrying a dead body inside of your own body is incredibly dangerous. It can be psychologically devastating. It could have killed her.

But “morality” demands that she get an infection before she can receive care.

And in emergency scenarios, Dr. Stulberg says, the newly merged hospital did not offer standard-of-care treatments. In one case that made the local paper, a patient came in with an ectopic pregnancy: an embryo had implanted in her fallopian tube. Such an embryo has zero chance of survival and is a serious threat to the mother, as its growth can rupture the tube. The more invasive way to treat an ectopic is to surgically remove the tube. An alternative, generally less risky way is to administer methotrexate, a drug also used for cancer. It dissolves the pregnancy but spares the tube, preserving the women’s fertility. “The doctor thought the noninvasive treatment was best,” Dr. Stulberg recounts. But Catholic directives specify that even in an ectopic pregnancy, doctors cannot perform “a direct abortion”—which, the on-call ob/gyn reasoned, would nix the drug option. (Surgery, on the other hand, could be considered a lifesaving measure that indirectly kills the embryo, and may be permitted.) The doctor didn’t wait to take it up with the hospital’s ethical committee; she told the patient to check out and head to another ER. (Citing patient confidentiality, West Suburban declined to comment, confirming only that as a Catholic hospital, it adheres to religious directives “in every instance.”)

In other words, the embryo matters more than you, even if it’s doomed. Under Catholic doctrine, you apparently cannot simply dissolve an embryo implanted in the fallopian tube; you have to remove the whole tube. The justification is that removing just the embryo is tantamount to abortion; removing the tube, though, terminates the “life” of the embryo as a side-effect. So we can pretend that — oops! — we didn’t mean to kill the embryo, it just kind of happened while we were taking away a woman’s ability to have children in the future. Can’t beat the logic there.

Oh, and your doctor doesn’t have to tell you that they may simply refuse to provide you with basic health care:

Sonfield notes that many refusal clauses do not require providers to warn women about restrictions on services or to refer them elsewhere. “You have to balance doctors’ rights with their responsibilities to patients, employers and communities,” he adds. “Doctors shouldn’t be forced to provide services, but they can’t just abandon patients.”

I agree that doctors should not be forced to provide a service just because a patient asks for it — there are ethical lines that they have to follow, and those lines can be blurry. But there are the fuzzy, outlier ethical issues, and then there are all the issues involved in reproduction. Ob-Gyns or ER doctors cannot possibly claim that they had no idea they would ever have to face medical issues that involved reproduction and women’s sexual health. I don’t see how they can possibly claim that they had no idea they would have to provide care for someone who lived according to a different set of beliefs.

And I wonder how this would all be received if it were members of minority religious groups who were refusing care. Ema gives one example:

Asks for some pain relief during labor. That’s when I inform her that I’m a Scientologist and that pain relief for pregnant women is against my religion. Five minutes of verbal sparring later [’cause what would providing medical care be without the patient having to beg and plead for it just a tad], I relent with an order for pain meds—but only after the patient tells me she needs pain control for a toothache, not to ease labor.

Now, this is just a woman we’re talking about here, so it might not be that big of a deal. But let’s say a young man goes to a school counselor. He says he’s depressed. He’s says he’s thinking of hurting himself or other people. He says he wants help, and he asks if the counselor knows a psychiatrist or mental health professional she could refer him to.

The counselor tells him that she would love to assist him, but psychiatry is the root of all evil. She tells him that it cased WWI, the rise of Hitler and Stalin, the wars in Bosnia and Kosovo, and the September 11th attacks. She tells him that she can, however, serve as his “auditor,” wherein she will use an E-meter and ask him a series of questions. Auditing, she says, will “help the practitioner (referred to as a preclear or PC) to unburden himself or herself of specific traumatic incidents, prior ethical transgressions and bad decisions, which are said to collectively restrict the preclear from achieving his or her goals and lead to the development of a “reactive mind”. ”

Is she doing her job? If this kid does end up hurting himself or someone else, should she be considered negligent? Or can she just say that she was following her religious beliefs, maintain her job, and continue refusing to refer troubled students to psychiatrists — indeed, encouraging them not to see psychiatrists?

Even if nothing dramatic happens, should the school maintain her employment?

Religious freedom is crucial. But if one is in a care-giving profession, it is not obscene to require that person to provide health and life-saving care.

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61 comments for “Do No Harm – Except to Women”

hmm, i wonder if a same-sex partner would count as another “unit”… prolly not, in this dude’s eyes.

just like anyone else, doctors who refuse to care for their patients should be fired and/or sued out of practice. if you’re not willing to do your job, you don’t deserve to have a job.

Kristen

June 28, 2007 at 6:01 pm

Thanks for the link. Very interesting. I’m currently reading (okay, listening to…who has time to read anymore?) Dawkins, The God Delusion. He makes a similar point about the huge sacred box we put around any idea just because it’s religious. I’m still working through where I think religion belongs in society, but I’m very sure this is not the correct result.

Thomas

June 28, 2007 at 6:27 pm

Here’s my proposal: the Absolute Referral Obligation.(a) Any medical provider refusing to provide lawful medical care on religious grounds must, within 72 hours for a procedure or treatment not requiring application within ten days, and otherwise within two hours, refer the patient to a provider ready, willing and able to provide the refused care.
(b) failure to comply with section (a) shall subject the provider to liability for all damages suffered by the patient as a result of the refusal to provide care, together with statutory damages of $10,000 for each violation and reasonable attorney’s fees.
(c) no person may insure against the payment of an award under section (b).

(c) is not really to the patient’s benefit, since it takes away a source of payment for serious injuries. However, it raises the deterrent effect. In the event of judgment, the doctor is personally on the hook for her attorney’s fees; and for $10,000 in liquidated damages even if there are no actual damages.

Sean Clayton

June 28, 2007 at 6:46 pm

Thomas, this is a great idea.

r.tavi

June 28, 2007 at 6:59 pm

I do not understand these people’s stance. Why would they choose an occupation that they know they cannot fulfill completely. If I have two left hands, I should not become a carpenter. If I have two left feet and not rythm, I should not become a dance instructor. If I believe abortion is a sin, I should not work in any reproductive health care related field.

As for religious freedom, by denying (in some cases livesaving) care for religious reasons, these doctors force their religion on women, who might not share they religion. So in addition to not doing their jobs and jeopardizing women’s health, they are hurting those women’s right to religious freedom as well.

Mary

June 28, 2007 at 7:20 pm

I do not understand these people’s stance. Why would they choose an occupation that they know they cannot fulfill completely. If I have two left hands, I should not become a carpenter. If I have two left feet and not rythm, I should not become a dance instructor. If I believe abortion is a sin, I should not work in any reproductive health care related field.

Because they want the power to do so. Some people of certain religions think if enough doctors of a certain belief (such as no pain medication for labor or abortion is evil) practice and refuse care the “problem” will magically go away, or the patient will not have any alternative. It comes down to controlling others, and their beliefs being the only true belief to have.

Sometimes I’m afraid I’m too open to other people’s beliefs as an atheist liberal and I’m going to get walked all over for it.

Cizungu

June 28, 2007 at 7:22 pm

I do not understand these people’s stance. Why would they choose an occupation that they know they cannot fulfill completely.

Perhaps these ghouls become doctors precisely in order to push their religious conceptions of health care onto women. A sort of hands-on conservative approach–since rampaging women are aborting all over the place, and even taking painkillers and other drugs instead of suffering for Jesus (a sure sign of the Western world’s moral decay!), there’s a need for honest and upstanding men willing to defend ol’-time traditions, harking back to the good ol’ days when women died in droves during or immediately after childbirth. Just as an action movie isn’t really an action movie without a couple explosions thrown into the mix, apparently childbirth isn’t really childbirth without screaming and dying women. Vicarious thrills, I guess.

Bitter Scribe

June 28, 2007 at 7:36 pm

That hospital should not see one single dime of my or anyone else’s tax money until they fire that son of a bitch.

If I were a woman – frankly, I might even do this now, I probably should – I would begin asking every doctor I visited, for whatever reason, whether their religious beliefs precluded them from performing or providing any treatment on or to women of any sort, and if so, request a new doctor or inform them that you will be seeing a new doctor in the future.

The miniscule saving grace of the medical system we have in this country is that, en masse, we have a large amount of buying power – even within HMOs! – with which to influence policy. We just need to exercise it.

Lizard

June 28, 2007 at 8:10 pm

Every one of these tales is bone-chilling, but the Cheryl Bray story is particularly insane: The doctor wasn’t even being asked to do a procedure with which he wasn’t comfortable; he just didn’t like the patient’s reasons for requesting the procedure. Jesus, what’s next? Can my ophthamologist refuse an eye exam because he doesn’t approve of the books I’m planning to read?

Mermaidshoes—I had the same reaction. If the other “parental unit” had been female, I’m sure the good doctor would have fainted dead away in righteous horror.

How about this: Any doctor who refuses to prescribe EC to a rape victim should be charged with the crime of revictimization, which would carry the same penalty as rape, including forcing said doctor to register as a sex offender.

The trauma that the doctor inflicted upon that woman was surely as severe as the trauma inflicted by the rapist.

My understanding is that not only are the people taking these jobs because they want to deny women their reproductive freedom, they’re actually being instructed by their church leaders to go to pharmacy school so that they can do this.

I want to be able to find a link, but I’m having trouble scaring one up. Google fails me. :(

Brittany

June 28, 2007 at 9:29 pm

“My decision to refer Ms. Bray was not because she was unmarried; rather, it was based on my moral belief that a child should have two parental units,” he adds.

I wonder if this guy has ever heard himself speak. He’s saying the exact same thing (when you get right down to it) in a different way.

It’s not just the doctors who can refuse. It’s also the pharmacists.
And the hospitals and pharmacies can just “run out of stock” too.

Anne

June 28, 2007 at 9:57 pm

Elaine: The stories of pharmacist refusals have received some coverage in the past few years, in contrast to the doctor-related stories, which seem to be much rarer.

Seems like the next step up in the big refusal scheme is more doctors refusing to write the prescriptions to begin with….

Lindsay

June 28, 2007 at 10:05 pm

It was a bitch trying to get EC in Kentucky. In my case a condom broke when I was having consensual sex with my boyfriend. We went to a hospital first who said very plainly “We don’t provide that”, and it wasn’t even a catholic hospital!!!! Then we went to another health clinic nearby. The woman at the desk had to look up a doctor that would actually prescribe it for us. Fortunately there was one there. It was a young woman who was extremely kind and helpful to us. I had to have a pregnancy test first and all that jazz. Of course I felt like I was dying the entire time. She gave us two prescriptions. One with Plan B on it, and another one for another drug that she told us to use in case some asshole pharmacist wanted to pull any BS on us. She said the second one would make it less obvious what we were trying to do. Then we went to a Walgreens to get it filled and the asshole there said “Oh, we don’t have any here” even though a girl behind the counter said “The computer says we have that”. So I knew right there what his fucking problem was. But he at least sent us to a pharmacy that would give it to us. This whole process lasted from 11 in the morning to 8:30 at night. But I finally got it and now I can finish college and not have an abortion.
To this day I want to go to that Walgreens and tear some shit up.

exholt

June 28, 2007 at 10:09 pm

Thomas,

Good policy proposal.

In addition to implementing laws, there should also be an effort to tie the need to ensure patient care and well-being through the medical professional certification processes. By denying care and refusing to refer the patient to willing medical professionals, one can plausibly argue that the refusing doctor has violated the hippocratic oath and thus, show s(he) is unfit to practice medicine. Don’t think it will gain too much receptivity with the religious/right-wing lawmakers though.

Caja

June 28, 2007 at 10:34 pm

If I ever have the misfortune to run into one of these assholes, boy is he gonna get an earful. Or she, but for some strange reason I’m suspecting that’s less frequent.

And years ago my SO told me something his MD mother advised him: don’t let a woman you care about get any kind of pregnancy care at a Catholic hospital, because they will always always always put the life of the embryo/fetus/etc. ahead of the woman’s life. I cannot beLIEVE that crap about how they deal with ectopics!!

I once walked into an ER in western PA and asked for EC. The nurse told me, with a sneer, “We don’t do that here.”

No further information was volunteered.

I wouldn’t have been so passive if it wasn’t highly probable the man I slept with was sterile.

I was, however, livid.

Gabbi

June 28, 2007 at 11:46 pm

If a doctor can’t do their job correctly and thoroughly because of religious reasons then they shouldn’t be a doctor.

Nymphalidae

June 29, 2007 at 12:21 am

A very simple solution would be to prevent hospitals from being religiously affiliated. Why the fuck does religion need to get it’s grasping, dirty little hands on every single thing anyway?

I remember a while back the conservatives in Minnesota were QQing because the Muslims refused to carry alcohol in their cabs. I remember them saying that if they didn’t want to do their jobs they could quit. This affected the conservative men who wanted to carry home bottles of wine, so naturally it was a major crisis. It makes me so angry that I shake.

I realize they are in limited regions of the US, but everyone should be aware that Kaiser Permanente (HMO) on-site pharmacies stock Plan B. It is behind the counter as it is required to be, but in plain sight, so if you needed it you could walk in and no pharmacist could claim that they don’t carry it. They are open business hours, one evening a week, and Saturday mornings, but considering how long it might take you to get EC elsewhere, if you happen to be in an area with a Kaiser center, it’s a good thing to be aware of.

Of course, if you are heterosexually active, it’s an even better thing to keep one on hand if you possibly can.

If I were a woman – frankly, I might even do this now, I probably should – I would begin asking every doctor I visited, for whatever reason, whether their religious beliefs precluded them from performing or providing any treatment on or to women of any sort, and if so, request a new doctor or inform them that you will be seeing a new doctor in the future.

I was very heartened, on referral to a new OB/groino, to discover that in their bathroom there were posters on the inside of the door talking about emergency contraception, how to get it, and what to do if you run into an asshole pharmacist (okay, that’s not how they phrased it). It was very clear that the medical office would help you get emergency contraception if you needed it.

it’s against my religion to not punch a doctor or pharmacist in the face when they don’t provide proper medical care or the drugs i need. think that’ll fly?

noen

June 29, 2007 at 3:56 am

The dust up here in Minneapolis over the Somali cabbies wasn’t just about not wanting to carry alcohol in their cabs. It included dogs, since to them a dog is unclean. So the blind and other disabled people with guide dogs were unable to get a cab.

When it matters, government can be amazingly efficient. All depends on what matters though. It should be crystal clear that women’s issues simply do not matter to the right. Not like I have to tell anyone here that.

Dianne

June 29, 2007 at 3:59 am

If he wasn’t willing to write an EC prescription, she’d be glad to see a different doctor. Dr. Gish simply shook his head. “It’s against my religion,” he said, according to Boyer.

This quote made me practically start frothing at the mouth and looking for things to throw. Dr. Gish acted in a way that was contrary to accepted medical practice and highly unethical. He is allowed to not include any procedure in his practice that he feels uncomfortable with for any reason. But if he is unable or unwilling to provide a necessary service to his patient then he is required by all ethical standards and law to refer his patient to another practitioner who can provide her with proper care. He should lose his license and be sued for malpractice for this act. He failed to provide standard-of-care treatments and doing so is by definition malpractice. He needs to be taken out of the medical care system before he hurts anyone else. (Assuming, of course, that it really did happen the way it is described. It probably did, but there’s always the off chance that the patient is lying or simply wrong, ie did not understand what he was offering to do or not do properly.)

TheBends

June 29, 2007 at 6:17 am

Sometimes I’m quite relieved that as a guy, I will never have to experience a situation like that. Not just because of how awful it is for that poor woman, but also because I would be obliged to use violence. Something along the lines of “it’s against your religion is it? Well it’s not against mine, so you either get some EC, or find someone else who will, before I put your bullshit religion to the test!”

That is my opinion as an atheist, and also as someone predisposed to really enjoy violence when I know I’m firmly in the right.

micheyd

June 29, 2007 at 7:49 am

it’s against my religion to not punch a doctor or pharmacist in the face when they don’t provide proper medical care or the drugs i need. think that’ll fly?

Mine too!

Holy be.

Blunderbuss

June 29, 2007 at 8:13 am

In the great, glorious day where I Rule The World, any doctor who refuses to give medical treatment would then be barred from any sort of medical treatment themselves, barring emergancies. And then it’s up to the individual doctor treating them to decide what an ’emergancy’ is.

Unless it’s against their religion. “Oh, I’m sorry. You need a blood transfusion, but I’m a Jehova’s Witness, and that’s against my religion. We’ll have to send you elsewhere.”

Good luck with any malpractice claim based on a doctor’s refusal to prescribe EC. Courts have ruled that doctors and pharmacists may refuse to dispense EC if doing so violates their personal beliefs; however, they must provide a referral to a facility where EC is available.

My personal belief says that doctors refusing to provide EC to victims of sexual predation are violating their Hippocratic oath and should have their license suspended.

How many of these morally superior doctors would challenge a patient’s request for Viagra? Now tell me that our society doesn’t discriminate against women.

Rhiannon

June 29, 2007 at 8:22 am

Okay… I know the Constitution says “Freedom OF Religion” but it also says “Freedom FROM Religion”. Convienient how those Fundies always forget THAT part.

Dianne

June 29, 2007 at 8:36 am

Good luck with any malpractice claim based on a doctor’s refusal to prescribe EC. Courts have ruled that doctors and pharmacists may refuse to dispense EC if doing so violates their personal beliefs; however, they must provide a referral to a facility where EC is available.

Which the doctor in the example given refused to do. That is clearly, unquestionably malpractice.

My personal belief says that doctors refusing to provide EC to victims of sexual predation are violating their Hippocratic oath and should have their license suspended.

In principle, I don’t entirely agree with you here. If a doctor believes that he or she is not competent to prescribe a certain medication safely then s/he should not prescribe it, but should refer the patient to someone who can safely prescribe said med, if the indication is clear. This rule usually gets invoked when we’re talking about chemotherapy or presser support or something hard, though. Plan B is an oral drug with a good, well established safety profile*. If you can’t figure out how to prescribe it safely you shouldn’t be in medicine at all. Not as a doctor, nurse, pharmicist or hospital janitor.

*Ok, ok, if a patient with a history of factor V leiden, prothrombin mutation, 3 unprovoked DVTs and a large patent foramen ovale comes in and asks for plan B I can see consulting a hematologist first. But a woman with no past medical history? Give me a break.

Betsy

June 29, 2007 at 9:01 am

Thank God EC is now at least semi-available over the counter. This post, combined with the recent SCOTUS shenanigance, made for a depressing morning news reading.

Yuri K.

June 29, 2007 at 9:30 am

The Somali cabdriver thing in Minnesota seems spot-on for a comparison – and the right wing HOWLED. It was seen as just cause to ban Islam. So, evidently, women’s lives are worth less to them than a six-pack. Which must be why right-wingers always vote for ‘who they want to have a beer with.’

Kristen from MA

June 29, 2007 at 9:34 am

Excellent post, jill. Thanks!

Kristen

June 29, 2007 at 9:49 am

I spoke to a friend of mine who is currently an ER doctor. He was livid and had a few interesting insights about the intersection of belief and medicine. (This was his email with his permission and some swearing edited out…. :) )

The entire issue is [idiotic]. As a doctor I do things to assist people in doing thing I think are moronic or just wrong every damn day. Like today some [dumbass] took his 5 year old out for a motorcycle ride and predictably they end up in my ER. The guy is mostly just stitches. But the kid is a disaster. Right arm and leg in bits. Can I say its against my system of beliefs to release him to his father? Can I not resuscitate a person just because I wouldn’t want to live life in a PVS? Can Jack [his friend who is a surgeon] tell his patient, that sixty year old dude who is taking a piece of his son’s liver even though he refuses to give up drinking, that he won’t do the surgery because he thinks it wrong? NO. Its our job to provide medical care irrespective of our personal moral beliefs. The ethics of an act have to rest with the patient. And its my job to give a female patient contraception if she asks for it and tell her about it if she doesn’t. And there are plenty of ERs in this country to work at if my hospital disagrees. Those doctors are a disgrace.

Susan

June 29, 2007 at 10:06 am

Along with Thomas’ great suggestion, it strikes me that the last thing these hospitals and the other health care organizations employing these jerks want is bad publicity. Highlighting these stories on feminist blogs helps, but there are so many of them, it’s hard to keep track of who I should boycott/complain about (various states have regulatory agencies to which you could complain). It would be nice to have a Bad Faith Actors List maintained in some prominent webplace (HuffPost? Consumers Union? Michael Moore’s Sicko site?) to which names and stories could be added as they become available. For a hospital or clinic to be removed from the BFAL, they’d have to prove that they downsized the offending doctor and taken corrective action– such as educating the rest of their staff on the importance of the simple, overriding medical concept that the patient comes first.

I read this article in Self (yes, I occassionally read Self… but only when I’m waiting for Bitch to arrive) and promptly ripped it out and sent it to my Mom. I love that a mainstream magazine is covering these issues. Somehow, my Mother feels that Self has more authority than her crazy, vegan, feminist daughter. Whatever gets her to the polls, is what I say.

This really underscores the need for all women to have a pack of EC in their medicine cabinet and not look for it when they “need it” and waste valuable time looking for a doctor who doesn’t have his head up his ass.

Even if you yourself are on BC, have been sterilized, are menopausal. Because you have friends and family and loved ones who are fertile. Keep it in your medicine cabinet. Be the compassion that these “doctors” refuse to be.

bmc90

June 29, 2007 at 11:01 am

My husband works in an ER and patches up drug dealers, prostitutes, alcoholics, and 400 pound people all the time. All of them are there in part because of poor life choices. Three points. First, it is apparent that the right thinks such folk are more deserving than women of proper medical care. Hell, alcholics even get beer proscribed in the hospital while they are going through withdrawal. Second, the ER is the wrong place to undergo a progarm to reform behavior, thought that is clearly what the right is planning to do. Third, I plan to try to interest local reporters in doing stories on local hospitals’ EC policies so that women can be informed as much as possible before making choices.

Here is a chilling thought. Gish making medical decisions for you while you are unconscious. It makes me really glad to be married to someone smart and agressive to speak for me in this instance. Unfortunately, non-spouses are not accorded the same voice without a lot of paperwork being in place, and even then, if the doctors won’t listen you will have to lawyer up fast. But to end on a lighter note, how about creating a wrongful birth cause of action for doctors who refuse EC? Doctor could be on the hook for the ENTIRE cost of raising the child, even if the mother gives it up for adoption. THAT will get them writing perscriptions.

Christina B

June 29, 2007 at 11:22 am

I agree completely with Auguste. I wrote someone on another thread that those of us who have the time and can should interview any and every doctor before utilizing their services. I am going to go a step further and say that we should also refuse to pay a consultation fee if after the interview, we are not comfortable with the doctor.

Perhaps being “interviewed” by a potential patient will check their egos a bit, it will definitely check their power and losing money will perhaps encourage them to change their policies.

Of course this doesn’t apply to emergency situations.

Anne

June 29, 2007 at 11:24 am

FYI, unless this has changed (and I hope it hasn’t) last I heard the CVS chain of pharmacies is required by corporate to fill all legitimate prescriptions.

If possible, don’t go to Walgreens at all. Go to CVS.

micheyd

June 29, 2007 at 11:26 am

When I read stories like this, I have the momentary urge to buy tons of EC and travel cross-country through various towns and cities, where I will pass my time with my ear to the ground, waiting to hear of refusals. Or perhaps I could keep a running list of asshole docs and pharmacists, and hang out there (without violating anyone’s privacy, of course). Then I will give EC for free to women who need it, and encourage them to set up a similar underground system for women in their area.

I could bill myself as the EC Queen, a la the Condom King of Thailand :)

bmc90

June 29, 2007 at 11:41 am

Actually, Mich, I’m planning to get an EC perscription and just tell the kids who are about to be teenagers where I keep it. If it ever disappears, I’ll go get another one and intiate a gentle discussion about what went wrong and what we can do so it does not go wrong again. I don’t want a 16 year old having to face down one of these guys during a crisis.

ks

June 29, 2007 at 12:04 pm

Seriously.

Y’all, I’m just waiting for one of these fuckers to mess with me. I especially look forward to the moment when, staring them down, I place a call to my lawyers and clearly enunciate “mal-prac-tice.”

I feel the same way. I’m just evil enough that when I get really pissed off (and that would definitely do it) that they would surely regret it.

Personally, I think that when these assholes refuse to prescribe EC for religious, ‘life of the goddamned embryo’ reasons, then they should be forced to pay for the subsequent abortion if that’s what the woman chooses or for the entire cost of giving birth to and raising a child if that’s what she chooses, plus punitive ‘suffering and anguish’ money.

anna

June 29, 2007 at 2:07 pm

Off Topic: So what happened to those cab drivers refusing to transport alcohol and guide dogs? Do they have to transport them now?

The Red Shredder

June 29, 2007 at 2:55 pm

Hi – Long time lurker, first time commenter. I moved into a new city a year ago for a job. I got a new PCP and was pretty happy with her care. She was actually pretty liberal with the scripts and gave me a year’s worth of several medications I take regularly. She even told me she could do my yearly exams, so I wouldn’t have to find a new GYN. I thought I had hit the jackpot.

Well…
About a month before Plan B became available over the counter, my husband and I had a condom slip during the middle of my cycle. I called my doctor’s office the next day and told them my issue, even joked a bit about it. I figured the doctor would call me in a script and I’d be fine. The office worker who answered the phone listened to my story and told me coldly that the office couldn’t help me. I asked to speak to my doctor, and was told she would call me. She called me back over 6 hours later and told me that the office’s policy was not to dispense Plan B under any circumstances. When I asked her to refer me to another doctor, she was unable to think of any one who would possibly prescribe Plan B to me.
Luckily, there is a Planned Parenthood clinic in this city and the next morning (day 3) I went to see them. I had to let the doctor there do an exam before they would give me the script, and I had to pay out of pocket for the exam and the script, because they couldn’t take my insurance. So $240 dollars later, I had my two, tiny Plan B pills and still another 2-3 weeks of worrying if I had caught things in time. I was fine, this time. But what tiny faith I had in doctors was gone because of this incident.

Thomas

June 29, 2007 at 3:26 pm

bmc, my wife just told our tween niece where we keep the condoms. If she can’t level with her mother or buy them herself, then she is no way ready to deal with a pregnancy or STI. I hope she won’t need them for several years; but hope is not a plan.

JPlum

June 29, 2007 at 3:29 pm

This type of thing never seems to happen in Canada, or maybe I don’t hear about it. I go to a Muslim doctor, who is observant enough to wear a hijab, ankle-length skirts, and long sleeves, at a clinic affiliated with a Catholic hospital, and no one has ever even blinked at my birth control prescription. Your first visit they ask about your sexual orientation, but in a completely non-judgemental, in order to give you the most appropriate care kind of way. We just don’t allow that kind of religious bigotry in Canada, do we?

I’ve no idea if I could get an abortion through the hospital, but I’m sure they would refer me somewhere. Because not to refer me would be…I don’t know…immoral and illegal?

Autumn Harvest

June 29, 2007 at 7:36 pm

The Minnesota cab drivers now do have to accept all passengers, including those with alcohol or guide dogs, or else they lose their taxi license. Under the old system the cab drivers could go to the back of the taxi line, and the passenger could just take the next taxi in line; which makes the analogous situation one where the doctor doesn’t prescribe EC, but refers you to the doctor down the hall who does.

Yes, you do. Don’t assume that because Canada is very far ahead of the US on many social issues that all Canadians everywhere are enlightened, nonsexist folk.

zuzu

July 1, 2007 at 10:46 pm

This type of thing never seems to happen in Canada, or maybe I don’t hear about it. I go to a Muslim doctor, who is observant enough to wear a hijab, ankle-length skirts, and long sleeves, at a clinic affiliated with a Catholic hospital, and no one has ever even blinked at my birth control prescription.

It’s never the members of a minority religion who are the problem; it’s always the members of the majority religion. Which Canada doesn’t seem immune from.

There needs to be Truth in Healthcare legislation. There is generally acceped medical practice and then there is sectarian medical practice. If Roman Catholic and fundamentalist health care providers want to practice based on their religious dogma, their patients must be informed beforehand. “Gotchas” by doctors or pharmacists or other providers result in poor outcomes for the patient and higher cost of care.